HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Volkmar Falk Thomas Walther Gerhard Wimmer-Greinecker Friedrich W. Mohr Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Falk, V. Articles by Mohr, F. W. Search for Related Content PubMed PubMed Citation Articles by Falk, V. Articles by Mohr, F. W. Related Collections Minimally invasive surgery

J Thorac Cardiovasc Surg 2003;126:1575-1579
© 2003 The American Association for Thoracic Surgery

Evolving technology

Facilitated endoscopic beating heart coronary artery bypass grafting using a magnetic coupling device

^a Department of Cardiac Surgery, Heartcenter, University of Leipzig, Leipzig, Germany
^b Department of Clinical Development Engineering, Intuitive Surgical, Sunnyvale, Calif, USA
^c Department of Cardiology Heartcenter, University of Leipzig, Leipzig, Germany
^d Department for Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany

Received for publication August 20, 2002; revisions received September 30, 2002; revisions received November 13, 2002; accepted for publication January 28, 2003.

^* Address for reprints: Volkmar Falk, MD, PhD, Klinik für Herzchirurgie, Universität Leipzig Herzzentrum Strümpellstr. 39, 04289 Leipzig, Germany
falv{at}medizin.uni-leipzig.de

BACKGROUND: Suturing of a coronary anastomosis in totally endoscopic coronary artery bypass grafting on the beating heart is technically demanding. The potential benefits of the endoscopic Magnetic Vascular Positioner device (Ventrica, Inc, Fremont, Calif) to facilitate construction of a coronary anastomosis in a closed chest environment were evaluated.

METHODS: Totally endoscopic coronary artery bypass grafting on the beating heart was performed in 8 foxhound-beagle inbred dogs with the da Vinci telemanipulation system (Intuitive Surgical, Mountain View, Calif). A prototype of the endoscopic Magnetic Vascular Positioner device was used to facilitate construction of the coronary anastomosis. One pair of magnets was inserted in the internal thoracic artery and left anterior descending artery using robotic instruments to guide and place the endoscopic delivery platform. All animals underwent angiography; gross inspection of the anastomotic site was performed after excision of the hearts.

RESULTS: The procedure was accomplished in all animals in 169 minutes (155-190 minutes). Dissection of the left anterior descending coronary artery (6.5 minutes; 1-20 minutes), positioning of the stabilizer (8.5 minutes; 7-16 minutes), placement of occlusion tapes (6 minutes, 3-10 minutes), and arteriotomy 5.5 minutes (3-30 minutes) was achieved without problems. By use of the Magnetic Vascular Positioner device, the anastomosis at the graft site was performed with the graft still in situ. Except for 1 premature deployment, all other deployments were easily accomplished in 3 minutes (1-28 minutes). The following adverse events were encountered: bleeding from the right ventricle caused by occlusion tape (1), anastomotic leakage on reperfusion requiring repair stitches (2), and anastomotic occlusion as a result of thrombus (1). All except 1 animal with a patent graft and anastomosis survived the procedure. The overall patency was 7 of 8.

DISCUSSION: The combination of robotic technology allowing for dexterous manipulation in a closed chest environment and a simple yet effective and timesaving technique for anastomotic coupling may facilitate beating heart totally endoscopic coronary artery bypass grafting.

This article has been cited by other articles:

				V. Falk and F. W. Mohr Minimally Invasive Myocardial Revascularization Card. Surg. Adult, January 1, 2008; 3(2008): 697 - 710. [Full Text]

				S. Jacobs, D. Holzhey, H. Stein, F. W. Mohr, and V. Falk Catheter-Based Endoscopic Bypass Grafting: An Experimental Feasibility Study Ann. Thorac. Surg., November 1, 2007; 84(5): 1724 - 1727. [Abstract] [Full Text] [PDF]

				T. P. Martens, M. Argenziano, and M. C. Oz New Technology for Surgical Coronary Revascularization Circulation, August 8, 2006; 114(6): 606 - 614. [Full Text] [PDF]

				V. Falk, S. Jacobs, and F.-W. W. Mohr Closed-chest, robotically assisted CABG MMCTS, March 15, 2006; 2006(0315): 935. [Abstract] [Full Text] [PDF]

				D. Y. Loisance, K. Nakashima, and M. Kirsch Computer-assisted coronary surgery: lessons from an initial experience Interactive CardioVascular and Thoracic Surgery, October 1, 2005; 4(5): 398 - 401. [Abstract] [Full Text] [PDF]

				V. Falk, F. Mourgues, L. Adhami, S. Jacobs, H. Thiele, S. Nitzsche, F. W. Mohr, and E. Coste-Maniere Cardio Navigation: Planning, Simulation, and Augmented Reality in Robotic Assisted Endoscopic Bypass Grafting Ann. Thorac. Surg., June 1, 2005; 79(6): 2040 - 2047. [Abstract] [Full Text] [PDF]